Pansiritanachot Wasin, Riyapan Sattha, Shin Sang Do, Chantanakomes Jirayu, Thirawattanasoot Netiporn, Rangabpai Wichayada, Somboonkul Bongkot, Jeong Joo, Song Kyoung Jun, Chiang Wen-Chiu, Jamaluddin Sabariah Faizah, Kajino Kentaro
Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Siriraj, Bangkoknoi, Bangkok, 10700, Thailand.
Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Int J Emerg Med. 2024 Dec 20;17(1):193. doi: 10.1186/s12245-024-00787-y.
Evidence regarding the effect of time to neurosurgical and neuroradiological intervention on outcomes in traumatic brain injury (TBI) across Asia-Pacific region is limited. This study evaluates the quality of care and outcomes for TBI patients undergoing neurosurgical and neuroradiological procedures at different timings.
Adult TBI patients who received any neurosurgical or neuroradiological interventions during the year 2015-2022 in the Pan-Asian Trauma Outcome Study database were analyzed. The time to intervention, as the main exposure, was classified into three groups (Early, Intermediate, and Delayed) using Restricted Cubic Spline (RCS) analysis. The outcomes were in-hospital mortality and unfavorable neurological outcomes. W score was utilized to compare the quality of care among exposure groups. Multivariable logistic regression analysis and interaction analysis were performed to identify the association between the exposure groups and outcomes, reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI).
A total of 1,780 patients were included. From the RCS analysis, patients were classified into three groups according to time to intervention: Early (< 1.9 h), Intermediate (1.9-4.1 h), and Delayed (> 4.1 h). According to the time to intervention, W score was - 8.6 in the early group, -1.1 in the intermediate group, and + 0.4 in the delayed group. Patients receiving intermediate and delayed intervention showed significantly lower mortality (AOR 0.64, 95% CI 0.47-0.86 and AOR 0.66, 95%CI 0.48-0.90, respectively).
Early neurosurgical and neuroradiological interventions in TBI patients in the Asia-Pacific region were associated with lower quality of care and higher mortality. The quality of care should be focused and improved during the early hours of TBI.
关于亚太地区创伤性脑损伤（TBI）患者接受神经外科和神经放射学干预的时间对预后影响的证据有限。本研究评估了不同时间接受神经外科和神经放射学手术的TBI患者的护理质量和预后。
分析2015年至2022年期间在泛亚创伤结局研究数据库中接受任何神经外科或神经放射学干预的成年TBI患者。以干预时间作为主要暴露因素，使用受限立方样条（RCS）分析将其分为三组（早期、中期和延迟）。结局指标为住院死亡率和不良神经学结局。采用W评分比较各暴露组之间的护理质量。进行多变量逻辑回归分析和交互分析，以确定暴露组与结局之间的关联，结果以调整优势比（AOR）及95%置信区间（CI）表示。
共纳入1780例患者。根据RCS分析，患者按干预时间分为三组：早期（<1.9小时）、中期（1.9 - 4.1小时）和延迟（>4.1小时）。根据干预时间，早期组的W评分为 - 8.6，中期组为 - 1.1，延迟组为 + 0.4。接受中期和延迟干预的患者死亡率显著较低（AOR分别为0.64，95%CI 0.47 - 0.86和AOR 0.66，95%CI 0.48 - 0.90）。
亚太地区TBI患者早期进行神经外科和神经放射学干预与较低的护理质量和较高的死亡率相关。在TBI的早期阶段应关注并改善护理质量。
